Fixed versus individualized treatment for five common bacterial infectious syndromes: a survey of the perspectives and practices of clinicians.
Journal
JAC-antimicrobial resistance
ISSN: 2632-1823
Titre abrégé: JAC Antimicrob Resist
Pays: England
ID NLM: 101765283
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
09
05
2023
accepted:
26
06
2023
medline:
3
8
2023
pubmed:
3
8
2023
entrez:
3
8
2023
Statut:
epublish
Résumé
Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates. We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations. Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI. There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.
Sections du résumé
Background
UNASSIGNED
Traditionally, bacterial infections have been treated with fixed-duration antibiotic courses; however, some have advocated for individualized durations. It is not known which approach currently predominates.
Methods
UNASSIGNED
We conducted a multinational clinical practice survey asking prescribers their approach to treating skin and soft tissue infection (SSTI), community-acquired pneumonia (CAP), pyelonephritis, cholangitis and bloodstream infection (BSI) of an unknown source. The primary outcome was self-reported treatment approach as being fully fixed duration, fixed minimum, fixed maximum, fixed minimum and maximum, or fully individualized durations. Secondary questions explored factors influencing duration of therapy. Multivariable logistic regression with generalized estimating equations was used to examine predictors of use of fully fixed durations.
Results
UNASSIGNED
Among 221 respondents, 170 (76.9%) completed the full survey; infectious diseases physicians accounted for 60.6%. Use of a fully fixed duration was least common for SSTI (8.5%) and more common for CAP (28.3%), BSI (29.9%), cholangitis (35.7%) and pyelonephritis (36.3%). Fully individualized therapy, with no fixed minimum or maximum, was used by only a minority: CAP (4.9%), pyelonephritis (5.0%), cholangitis (9.9%), BSI (13.6%) and SSTI (19.5%). In multivariable analyses, a fully fixed duration approach was more common among Canadian respondents [adjusted OR (aOR) 1.76 (95% CI 1.12-2.76)] and for CAP (aOR 4.25, 95% CI 2.53-7.13), cholangitis (aOR 6.01, 95% CI 3.49-10.36), pyelonephritis (aOR 6.08, 95% CI 3.56-10.39) and BSI (aOR 4.49, 95% CI 2.50-8.09) compared with SSTI.
Conclusions
UNASSIGNED
There is extensive practice heterogeneity in fixed versus individualized treatment; clinical trials would be helpful to compare these approaches.
Identifiants
pubmed: 37533760
doi: 10.1093/jacamr/dlad087
pii: dlad087
pmc: PMC10391701
doi:
Types de publication
Journal Article
Langues
eng
Pagination
dlad087Informations de copyright
© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.
Références
J Antimicrob Chemother. 2013 Oct;68(10):2183-91
pubmed: 23696620
Chest. 2006 Oct;130(4):1165-72
pubmed: 17035452
Clin Infect Dis. 2016 May 15;62(10):e51-77
pubmed: 27080992
Am J Respir Crit Care Med. 2019 Oct 1;200(7):e45-e67
pubmed: 31573350
Clin Infect Dis. 2011 Mar 1;52(5):e103-20
pubmed: 21292654
CMAJ. 2008 Jul 29;179(3):245-52
pubmed: 18663204
Clin Infect Dis. 2000 Dec;31(6):1362-7
pubmed: 11096003
Clin Infect Dis. 2014 Jul 15;59(2):e10-52
pubmed: 24973422
Clin Infect Dis. 2016 Oct 15;63(8):1034-1041
pubmed: 27402819
Clin Infect Dis. 2007 Oct 15;45(8):983-91
pubmed: 17879912
Eur Respir J. 2017 Jun 15;49(6):
pubmed: 28619956
Ann Intern Med. 2019 Aug 6;171(3):153-163
pubmed: 31284301
Antimicrob Agents Chemother. 2018 Aug 27;62(9):
pubmed: 29987137
PLoS One. 2022 Jul 26;17(7):e0272021
pubmed: 35881618
Int J Antimicrob Agents. 2019 Aug;54(2):184-188
pubmed: 31085297
Int J Antimicrob Agents. 2011 Dec;38(6):480-5
pubmed: 21982833
BMJ. 2017 Jul 26;358:j3418
pubmed: 28747365